Care Services Research Articles

Liver Transplantation in Alcohol-Associated Hepatitis. Benefits and Limitations of Psychosocial Selection and Support in Alcohol Relapse. The Experience of a Tertiary Center in Italy

Patients with severe alcoholic hepatitis SAH may suffer of undiagnosed psychiatric illnesses, typically depression. Assessment of prevalence and potential impact of psychiatric disturbances on alcohol relapse after LT, were the main objectives of this study. One hundred consecutive patients with SAH from April 2016 to May 2023 were analyzed. All patients were evaluated by an integrated team including psychiatrists, addiction specialists and social workers. Thirty (30%) were listed, of whom 25 underwent early liver transplantation (eLT) after a median time of 36 days from the index episode of SAH with a median model for end stage liver disease (MELD) score of 36, whereas 33 (33%) were excluded, with psycho-social issues being the main cause of exclusion in 18 patients (54.5%). Twenty-four patients (96%) are currently alive after a median follow-up of 32 months from LT. Sixteen transplanted patients had major depression with or without anxiety, with 10 patients (33%) being treated with antidepressants post-LT. Overall, 4 patients (16%) relapsed into alcohol consumption after liver transplantation and 1 died of alcohol related liver disease (4%). From this experience emerged that psychiatric comorbidities are highly prevalent among patients with SAH and that their diagnosis/treatment contributed to mitigate the risk of alcohol relapse.

Alström syndrome: the journey to diagnosis

BackgroundAlström syndrome (AS) is a recessively inherited genetic condition which is ultra-rare and extremely complex. Symptoms include retinal dystrophy, nystagmus, photophobia, hearing loss, obesity, insulin resistance, diabetes and cardiomyopathy. The condition is progressive, but it is important to note that not all the complications associated with AS occur in everyone affected. Symptoms can also present at different stages, making diagnosis difficult. There are currently 88 people diagnosed with AS in the UK.ObjectivesThe aim of this report is to raise awareness of the key symptoms of AS, in order to promote a faster and more effective diagnosis. This involves identification of individual or a combination of ‘red flag’ symptoms. Overall the findings should improve the patient experience, and their long-term health outcomes.MethodsBetween August-October 2022 we conducted research into a sample of patients from the ASUK database. The process involved a combination of interviews with families, social care and education reviews. Interviews were semi-structured using open questions and a patient-centred approach.ResultsSeventeen newly diagnosed patients were included in our sample. Only 24% of patients were diagnosed within one year following the onset of AS symptoms. Patients with visual impairment and cardiomyopathy were diagnosed much more quickly, either in infancy or early childhood. 41% of our research participants waited over 5 years for a diagnosis. Insufficient research and treatment advances can further impede the diagnostic process and limit access to therapies or clinical trials, ultimately impacting patient outcomes.ConclusionWhile we welcome these developments, our findings, and the evidence we have gathered in this report suggests that more needs to be done to improve the experiences of people receiving a diagnosis of AS. Obesity rapidly developing in infancy should be flagged as a key symptom to be aware of where AS is a possible diagnosis. Visual impairment (88%) in combination with cardiomyopathy (59%) is a frequent first presentation for patients with AS. Most patients (7/17) are diagnosed many years after symptom onset (5–20 years).

The Role of social group worker in family guidance consultation centers to dealing with Marital Lack of adjustment Problems in the perspective of group work

The Role of social group worker in family guidance consultation centers to dealing with Marital Lack of adjustment Problems in the perspective of group work

Requirements for professional performance development of school social workers for practice technology social work

Requirements for professional performance development of school social workers for practice technology social work

The British Geriatrics Society's position on assisted dying.

In response to increased focus on the issue of Assisted Dying (AD) in the UK due to the presentation of The Terminally Ill Adults (End of Life) Bill 2024-25 [1] and bills before parliaments in the Isle of Man, Guernsey and Scotland, the British Geriatric Society (BGS) recently developed a position statement opposing legalisation of AD in the UK [2]. We set out our key reasoning behind this position, namely the current adverse health and social care context and significant concern about whether effective safeguards can be created to protect older people with complex needs from undue harms. The BGS asks for improved, personalised, multidisciplinary care for older people at the end of their lives, including high-quality palliative and end-of-life care. It urges caution about legalisation and offers its expertise in any potential future shaping and implementation of AD legislation. This should include a conscience clause for professionals objecting to direct involvement. The main outcomes from a survey of member's opinions are also outlined [2]. The majority were against legalisation of AD; however, a significant minority were in favour, with some undecided. This diversity of opinion highlights a need for the Society to maintain balance and nuance on this difficult and emotive issue, warranting future BGS reviews if the relevant legislation changes.

Formation of Ukrainian identity of the population in the conditions of martial law

The issue of the formation of Ukrainian national identity in martial law is relevant to the future of the state and each of its citizens. Existing studies have focused only on the national-patriotic education of children and youth. Adults were not the subject of education in terms of national-patriotic education. And social workers were not engaged in social education of young and adult population in the context of the national idea and Ukrainocentrism. They focused on the problems of socialization of children and youth. Today, however, new forms of work with children and adults have emerged - educational activities on the Ukrainian Charter of the Free Man and community integration activities with the population, which should be combined and used by educators and social workers together. The purpose of the article is to identify and summarize new ways of forming the Ukrainian identity of children and adults in wartime. Research methods include theoretical analysis, generalization of experience, synthesis, document analysis, and observation. The research methodology at the level of scientific approaches is competence-based, Ukraine-centered, national security, environmental, self-help, and humanitarian response. The scientific novelty of the article is the explanation of the mechanism and possibilities of this new experience of combining integration measures with the principles of the Ukrainian Charter of a Free Man for better formation of Ukrainian identity in the conditions of war. The practical results of the study are a description of the possibilities of applying the new experience based on the analysis of new ways of forming the national identity of children and adults in wartime. The experience of integration activities with the implementation of an educational program for children and youth on the Ukrainian Charter of the Free Man in the Ternopil region of Ukraine is presented. On the basis of the Ternopil Regional Communal Institute of Postgraduate Pedagogical Education (Ternopil, Ukraine), scientific and practical conferences on the implementation of the Ukrainian Charter of a Free Man were held, which made it possible to spread the implementation of experience from the regional level to the All-Ukrainian level.

Identifying and Applying a Strength-Based Research Approach in Indigenous Health

Strength-based approaches are regarded as being effective in research with communities but there are minimal examples of application as a research approach, particularly in health, with Indigenous populations, and with youth. Systemic racism manifested through colonization, including in academic institutions, has contributed to historical and ongoing traumas by supporting the overuse of deficit-based approaches with Indigenous populations in many disciplines, including health. We present our creation and application of a strength-based methodological approach to research in health alongside Dene First Nation youth. It was developed on principles consistent with the strength-based paradigms in social work, psychology, and education. We share four main components of strength-based research approach: 1) identifying strengths, 2) prioritizing and creating descriptions of strengths, 3) refining strengths by gathering contextual examples, and 4) depicting strengths to plan future research. Each component included qualitative methods (such as asset-mapping, nominal group technique, storytelling interviews, and participatory 360-degree video) that reflected aspects of strength-based approaches and emphasized active participation, multiple knowledge sources, and empowerment. Utilizing this approach promoted connectivity to the larger environment, inclusivity of multi-knowledge sources, agency and voice, increased empowerment, and practicality in action. We share challenges and lessons learned from exploring a strength-based approach in health research and provide insights for researchers interested in applying a strength-based approach to research, particularly in Indigenous health.

Situational Analysis of Power in Participatory Action Research: Mapping Systemic Frameworks, Discourses, and Principles for Critical Feminist Qualitative Inquiry

In this current context, critical epistemologies, methodologies, and frameworks like Participatory Action Research (PAR), decolonial theory, and situational analysis can provide relevant tools for critical feminist social work research and praxis to expose and reenvision harmful, extractive, and privatized knowledge generation and dissemination. In this article, I describe the possibilities for using critical situational analysis to promote critical feminist social work scholarship through the interrogation of colonial forms of knowledge production, recognition of enactments of refusal and resistance, and illustrations of situational mapping from a study focused on exploring power differentials within PAR collaborations among social work faculty and community stakeholders. I then discuss possibilities to incorporate these analytic qualitative methodologies and frameworks to promote critical feminist principles for critical qualitative inquiry.

A Qualitative Exploration of the Financial Insecurity Experience Among Older People: Implications for Social Work Practice

The availability of support services to ensure financial security is crucial for older people, particularly those who experience functional disability and or financial incapacity. In Ghana, evidence show that many older people report being financially insecure, necessitating an examination of how social provisions such as the social work profession can innovatively and culturally promote financial security for older people. However, limited evidence exists on how social work can innovatively offer culturally appropriate contributions to address the financial security needs of older people in Ghana. Deploying a descriptive qualitative design, this study presents the qualitative findings of older people’s financial experiences across three Ghanaian regions. The study participants (N = 15) were purposefully sampled from Ashanti, Bono-East, and Central regions in Ghana to engage in semi-structured interviews. Analysis of participants’ experiences regarding their finances using NVIVO 20 resulted in six major themes namely: 1) source of finance; 2) reliability of financial sources; 3) adequacy of finances; 4) perspectives on financial soundness; 5) perceived status of financial security; and 6) preferred measures to improve financial status. These themes, put together, enhance our understanding of the seriousness of older people’s financial situation and a quest for financial security. The findings offer evidence for the social work profession in Ghana to adopt innovative and culturally sound approaches, including the ‘nnoboa’ strategy (a common concept in rural Akan communities in Ghana for cooperative cultivation and fundraising) in ensuring financial security for older people.

Clinical Case Report: Secondary syphilis in a child with no history of sexual abuse

This pediatric case report details the diagnostic and therapeutic challenges of secondary syphilis in a six-year-old child presenting with oral lesions and perianal condyloma lata. The diagnosis was confirmed through the Venereal Disease Research Laboratory (VDRL) test, and successful treatment was achieved with benzathine penicillin. The case presented significant diagnostic complexities, necessitating the evaluation of three potential transmission routes: late congenital syphilis, sexual abuse, and non-sexual transmission. Late congenital syphilis was excluded based on the absence of typical symptoms such as bone and dental abnormalities and neurosensorial deafness. Sexual abuse was thoroughly investigated and ruled out following an extensive four-month evaluation by a multidisciplinary team comprising a psychologist, nurse, social worker, and pediatric infectious disease specialist. Ultimately, non-sexual transmission, likely from an untreated family member, emerged as the most plausible cause, supported by the observation of overcrowded living conditions and inadequate hygiene practices in the child's environment. This case underscores the necessity of comprehensive diagnostic evaluations, including consideration of all possible transmission routes, in managing pediatric syphilis. Public health interventions focusing on improving living conditions and hygiene practices are essential to prevent similar cases.

Exploring the readiness to practice of underrepresented healthcare workers: A scoping review.

Studies across the extant literature suggest that less-experienced healthcare workers are more likely to experience adverse outcomes such as burnout, sick leaves, or intend to leave the profession. Thus, one's readiness to practice is an important element that requires more attention. While extensive research exists on the readiness of certain professions like nurses, a notable gap remains concerning other healthcare workers. This study sought to explore studies examining readiness to practice among various underrepresented healthcare workers. We conducted a scoping review to determine the available research related to clinical and nonclinical areas related to the readiness to practice of healthcare workers, excluding physicians and nurses. We examined three databases, MEDLINE, CINAHL, and PsycINFO, from 1 January 2000 to 31 December 2023. Our search focused on readiness to practice among various healthcare professions, whether clinically focused or broadly related to professionalism. Our search identified 41 articles meeting the inclusion criteria from several professions, including but not limited to physiotherapists and occupational therapists, pharmacists, osteopaths/chiropractors, and social workers. Overall, studies differed in assessing readiness to practice with a broad range of identified clinical competencies that varied between professions and regions. Nonclinical skills, such as communication, conflict management, and cultural competence, were common barriers across professions. Despite the heterogeneity in job roles, work settings, and geographical reasons, there is evidence to suggest that new healthcare professionals may be clinically adept but may be lacking in other nonclinical skills that could affect their work and well-being. With early-career healthcare workers particularly vulnerable to adverse outcomes in the workplace, future research should standardize core competencies, including nonclinical skills and well-being-related activities, as a prevention method across various health groups.

The Historical and Clinical Foundations of the Modern Neuroscience Intensive Care Unit.

The subspecialty of neurocritical care has grown significantly over the past 40years along with advancements in the medical and surgical management of neurological emergencies. The modern neuroscience intensive care unit (neuro-ICU) is grounded in close collaboration between neurointensivists and neurosurgeons in the management of patients with such conditions as ischemic stroke, aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, subdural hematomas, and traumatic brain injury. Neuro-ICUs are also capable of specialized monitoring such as serial neurological examinations by trained neuro-ICU nurses; invasive monitoring of intracranial pressure, cerebral oxygenation, and cerebral hemodynamics; cerebral microdialysis; and noninvasive monitoring, including the use of pupillometry, ultrasound monitoring of optic nerve sheath diameters, transcranial Doppler ultrasonography, near-infrared spectroscopy, and continuous electroencephalography. Neuro-ICUs are also capable of specialized neuroprotective management of medical complications, including sodium disorders, renal failure, respiratory failure, and hypertension. These units depend on an interdisciplinary team including speech and language pathologists, occupational and physical therapists, and social workers and case managers, who work to implement early mobilization and successful transition to rehabilitation centers. There are numerous models of neuro-ICUs ranging from "open" units in which patients are cared for in an ICU by an admitting attending, generally without involvement of an intensivist, to "semi-open" units in which intensivists act as consultants, to "closed" units in which the neurointensivist is the admitting attending. The utilization of neuro-ICUs is associated with improved outcomes including lower mortality rates, decreased ICU and hospital length of stay, and improved functional outcomes.

Risk factor for difficult cases at the comprehensive consultation services about medical, welfare and legal problems.

This study aimed to identify the associations between background factors (such as medical conditions, intractable diseases, welfare problems, disabilities, economic difficulties, legal problems, elderly adults, children, and foreign persons) and difficult cases to provide more thorough consultation services. A survey was conducted on people who participated in comprehensive consultation services on medical, welfare, and legal issues related to medical care, welfare, and legal matters held from April 2021 to March 2024. We analyzed risk factors that may be difficult to resolve using multivariate logistic regression. Multivariate analysis showed that the factor of "economic difficulty" was significantly more difficult to solve. When treating patients, doctors must consider the possibility of multiple underlying issues. It is advisable for doctors to be aware of the need to consult with social workers and legal professionals when necessary.

"We're Checking a Box and, You Know, Covering Our Own": Health Professionals' Descriptions of Hospital-Policy Making Regarding Child Welfare Reporting Related to Birthing People's Drug Use.

Hospital policies play a role in healthcare providers' decision-making about reporting birthing people who use drugs to child welfare. This study sought to understand how these specific hospital policies are made. We conducted semi-structured interviews with healthcare professionals involved in developing or revising hospital policies related to child welfare reporting for birthing people who use drugs. The interview guide was informed by an implementation science framework and focused on participants' experiences developing or revising these policies. We coded transcripts inductively, focusing on themes that emerged in the interviews themselves, and deductively, focusing on pre-determined aspects of the policy development process. Participants (N = 16) were physicians (69%), registered nurses (19%), and social workers (12%). The sample was drawn from all regions of the United States. Two themes emerged in data analysis. The first theme was that urine drug testing policies for pregnant and birthing individuals are seen as part of hospital child welfare reporting policies. Specifically, participants often described child welfare reporting policies as including criteria for urine drug testing and explained that the connection between urine drug testing and child welfare reporting policies was by design. The second theme was that the content of hospital child welfare reporting policies is a result of hospital politics and a focus on legal compliance. They described the legal compliance aspects of the hospital policies as serving to protect the institution and, occasionally, individual employees from legal consequences. The content of hospital policies regarding birthing people who use drugs appears influenced by political and legal considerations more than considerations of patient or public health.

Assisted Living, Residential Care, and Memory Care Staffing Level Dynamics: Oregon, 2017–2023

ObjectivesTo examine changes in staffing levels over time in Oregon assisted living and residential care (AL/RC) communities between 2017 and 2023. DesignLongitudinal study of licensed AL/RC communities. Setting and ParticipantsA total of 1720 setting-year observations from 535 individual AL/RC communities in Oregon between 2017 and 2023. MethodsPrimary data were collected through the Oregon Community-Based Care (CBC) study. Staffing levels were estimated as care staff hours per resident per day and reported overall and by staff type, including registered nurses, licensed practical nurses, certified nursing assistants, certified medication aides, unlicensed care staff, life enrichment staff, and social workers. Fixed-effects linear regression models were estimated to account for the time-invariant characteristics in the panel data. ResultsThe mean care staff hours per resident per day was 3 hours and 30 minutes (range, 3 hours and 11 minutes to 4 hours and 1 minute), depending on the survey setting year. The mean occupancy rate was 77.5% and declined significantly from 80.3% to 72.2% during the pandemic (P < .001). Staffing levels (overall and by staff type) varied significantly across AL/RC settings. There was an increase in staffing levels immediately after the pandemic started. Most (64%) of the variation observed in staffing levels could be attributed to between-AL/RC differences. On average, total care staff levels were 19 minutes higher in 2021 and 28 minutes higher in 2023 compared with 2017. Conclusions and ImplicationsThe wide range of staffing levels points to significant differences in operational structures, resource allocations, and resident characteristics across different communities, with implications for the quality of care provided to residents. Understanding the significant changes to staffing patterns (levels and mix) after the COVID-19 pandemic is crucial for developing policies to improve adaptability and resilience of AL/RC settings.

From trusted intruder to real collaborator: Mapping the ecosystem of stakeholders and community assets in a coastal region in England, with a focus on end-of-life care and bereavement support

While policy efforts to promote health through integration across sectors are not new, the 2022 UK Health and Care Act formalised Integrated Care Systems (ICSs) as legal entities with statutory powers in England. This includes a legal responsibility to commission adequate palliative and end-of-life care services, including bereavement support, for the communities they serve. Cross-sector partnerships that leverage community assets are recommended to tackle inequities towards the end of life and in bereavement. However, the nature of effective, equitable partnership remains unclear, and asset-based approaches have been criticised for neglecting issues of power and potentially transferring the responsibility for solving social and health injustices to communities. Aware of these debates, we critically explore the conditions that enable inclusive collaborative relationships and integration across sectors, as well as the barriers that prevent this, within the ecosystem of one coastal region in England. We conducted a system mapping study, drawing on theories of death systems, social capital, and service ecosystems, understood via Service-Dominant Logic (S-D L).Our three-phase participatory, qualitative study involved three community network meetings (attended by 35–55 stakeholders across sectors), a participatory digital mapping workshop (n = 19), and semi-structured interviews analysed using inductive thematic analysis (n = 15 stakeholders across sectors). Digital mapping showed weak or unstable bridging capital between sectors. Interviews highlighted that attending to the relational foundations of integration is essential but often omitted: opportunities and time to understand each other and co-create a shared vision, understanding differences and deepening connections, and, fundamentally, addressing power differentials. Failed attempts at generating bridging capital were linked to extractive relationships, widespread staff shortages and inadequate funding and resources, particularly in the VCSE. Understanding the nature of collaboration and social capital in a locality can support public health approaches which go beyond naïve calls for cross-sector collaboration to engender meaningful change.

Social assistance management and Social Work: the professional job market

Resumo: Esta pesquisa objetiva analisar aspectos da ocupação de assistentes sociais em cargos no órgão gestor das políticas municipais de assistência social. Realizaram-se a sistematização e a análise dos dados do Censo Suas e da produção acadêmica em Serviço Social sobre a inserção e a atuação profissional nesses espaços. Os resultados mostram uma predominância dos(as) assistentes sociais na gestão desta política, desafios na formação continuada e a existência de lacunas na produção acadêmica.

Research on Social Work’s Assistance in Agricultural Product Marketing Strategies for Yanhe Tujia Autonomous County against the Background of Rural Revitalization

Research on Social Work’s Assistance in Agricultural Product Marketing Strategies for Yanhe Tujia Autonomous County against the Background of Rural Revitalization

Systematic review of health and social outcomes among Indigenous People exposed to the child welfare system: a protocol

IntroductionThe link between parent-child separation through child welfare systems and negative health and social outcomes is well documented. In contrast, despite the over-representation of Indigenous children and youth in child...

The relationship between good governance and organizational performance through the mediating role of employee satisfaction

The 13th Plan of Thailand (2023–2027) states that good governance is a non-economic factor affecting economic development (Office of the National Economic and Social Development Board &amp; Office of the Prime Minister, 2023; Solaymani &amp; Montes, 2024). This study examines the influence of good governance on organizational performance through mediation of employee satisfaction in business companies. Good governance comprises four factors: social development, economic management, employee participation, and work orientation. Self-administered questionnaires were distributed to respondents working at business companies in Thailand through a convenience sampling online survey of 395 respondents. The Statistical Package for the Social Sciences (SPSS) v. 29 was employed for descriptive analysis, and ADANCO v. 2.3.2 was used to test the hypotheses. The partial least squares structural equation modeling (PLS-SEM) shows that employee satisfaction mediates good governance and organizational performance through social development and economic management (but not employee participation and working orientation). To boost employee satisfaction and performance, businesses should adopt good governance. Business companies should prioritize economic management, social development, employee participation, and working orientation for effective governance. Company policies that promote openness could help economic management. Lifelong learning and transparency in human resource skill development could also boost social growth for the organization. Qualitative interviews provide more insight into additional research.